Suck re-training

Suck re-training is the same technique as finger feeding except, now you are trying to maintain the efficient suck and give the baby sufficient volume in a reasonable time. You have become the infant’s feeding coach. The total feeding time should be about 30 minutes. Longer than this and you will be getting tired, cranky and frustrated and so will baby.

This strategy uses the finger feeding technique, but requires the parent to understand the principles of oral mechanics and coach baby in suck efficiency. Just as in any sport the muscles need to be used correctly. In this case:

No biting

No clamping

No leakage of milk from corners of mouth

No clicking noises (as tongue breaks the seal)

Checking jaw position

For Mums: suck re-training is the strategy you want to use to prevent sore, damaged nipples. Do the 5-6 corrected sucks on your finger, then put baby to breast. If it hurts after 3-4 sucks, remove baby and repeat suck re-training. Again, do about 5-6 corrected sucks, then put to breast. And again. Only do this 3 times if you are in pain – now give the rest of the milk required by finger feeding, or by a correctly used bottle. Think of the bottle as if it was the breast – use teat to open mouth, aim teat towards the roof of the mouth (not angled down onto tongue), stabilize jaw with your index finger, check lips for good flanging, no leakage, used temporary cheek pressure if necessary. There is not a lot of point in damaging your nipples by continuing to do the very thing that caused the damage in the first place. Be a coach for your baby and teach him what he needs to learn.

Digital suck re-training method used by the mother. First wash your hands.

Have 20-30 mls expressed breast milk in a small plastic container or feeding bottle. You will need a No 5 IG tube (90 mm) and a small (2-3 ml) syringe for cleaning it.

Procedure Check for

Place baby comfortably on a pillow beside you with head tipped slightly back

Baby sitting at 30-45 degree angle.

Pillow under shoulders.

Slide your index finger on to roof of mouth his behind the top gum

There are suck sensors on the hard palate, so maintain firm contact with the palate.

Look to see that his lips close around your finger: lips and tongue make an airtight seal

Chin pressure or cheek pressure may be required to achieve this.

Note the position of the tongue

If it feels hard the tongue is not extended to protect your finger. This is why nipple damage occurs.

Insert the end of the tubing with the 2 small holes beside your finger.

Ensure the other end is in the milk.

When baby starts sucking, watch to see if he needs to open his mouth after a few sucks – to breathe.

If he does open mouth or roll up to take a breath – use some chin and cheek pressure to close the mouth. Nerve messages will go to the brain to help him learn a more efficient method.

Check how the milk is flowing along the tube to the mouth.

If it is progressing in fits and starts – 1 cm at a time – he has a dysfunctional suck.

If the milk goes from container to mouth in 2 sucks (90 mm tube) – the suck is efficient.

After baby has achieved 5-6 good sucks, rotate your finger 180 degrees and sweep out of mouth.

When removing finger it is beneficial to press down on the jaw/tongue as you sweep finger out of his mouth. It helps to relax the TMJ.

Now, put baby on to the breast, remembering all you have learnt about good positioning and deep attachment.

If baby attaches well and stays there – just proceed with the feed. If it hurts, take him off and repeat the suck training process: 5-6 good sucks, rotate finger, press down, put to breast.

Do this for 3 attempts: finger/breast, finger/breast, finger/breast.

Don’t do it so often that you become exasperated. It is a training session.

Now you can give baby the recommended volume of EBM by finger feeding or bottle feeding. Congratulate yourself

This ensures that baby is getting sufficient fluids into his system, and helps stop you from worrying about ‘how much he has to have’.

Washing milk collection and feeding equipment in a country like Australia with a safe water supply is the same as washing glassware. Rinse in cold water, wash in hot soapy water, air day. You can do this to the tubing, using the syringe:

first cold water, then

hot soapy water, then

some air – use the syringe to push the air through it.

Store the tubing in the fridge till the next feed. Do not microwave the tube – it will melt. Check that the cap is not on the tubing when you do the next feed – if it is, you will think –“baby is sucking well, why is there no milk going up the tube?’ – check the cap is OFF. (better still – cut the cap off).

For Dads: oral motor (muscle) mechanics required the same conditions as the carburetor – good airtight gasket. If the gasket leaks efficiency is compromised. My son-in-law suggested we need a ‘tit mechanic’ – but really it’s baby’s mouth that is the primary factor in feeding ‘success’. When baby is sucking on your finger and the milk is flowing well, then you can lift the bottle/milk container so that it is higher than baby’s head. This is a ‘gravity assisted feed’ but helps baby to cope with a faster flow of milk. Hold it up for 5-6 sucks then return to the normal position – level with baby’s mouth.

How do you know if this technique is working? Or if baby is sucking efficiently?: When baby is sucking well, the milk (a small bubble in the milk) can be seen to travel across the length of the 100cm tubing in just two (2) sucks. This is easy to see if only a small amount of milk (10 mls) is in a container and you wait and watch as he gets to the end of it. The ‘end’ of the milk will go across the tubing in 2 sucks. If it takes more than that – he still needs to practice.

Short intensive training is more efficient than training sessions which are spaced out (the same as with cricket teams who go away for a whole week clinic to perfect a new technique). Three feeds/sessions each day are usually enough. Some babies ‘get it’ quicker than that. When he ‘gets it’, you can start thinking of the suck re-training as an insurance policy (only use it if another challenge arises e.g. blocked nose and he starts biting again.

Finger size: use the one that suits baby best at first, then increase the size finger used e.g. little finger, index finger, middle finger, thumb, dad’s finger. The idea is to use what baby will accept, but to increase the diameter of the finger so that a good oral gape is achieved. Babies who bite, want to keep the jaw ‘shut’, but they also want to feed – so they move the jaw as little as possible. The mother may notice that her nipple is squashed (nipple compression line) when baby comes off the breast. If baby gags, go back to the finger that he was comfortable with, for this feed and try the larger one next feed.

The reason you are even trying suck re-training is because (most likely) baby has already caused damage to the nipples. It is excruciating, so feeding will be a very serious event for the mother. Once the suck starts to improve, the nipples heal very quickly. Think of yourself at footy training – practice, practice, practice. However a newborn actually ‘learns’ faster than adults – give the right input, you get the right output – efficient feeding. The following is an excerpt from my book, Breastfeeding is not a spectator sport:strategies for the domestic coaching team. I hope it helps you, in your current situation.

Feeding does not happen ‘on its own’ – the whole domestic environment is involved. Fly-in/fly-out dads do create a bit of stress, both coming and going – but that is reality. If you can get baby feeding right before you leave, mum and bub will be less stressed. So try this.

Suck re-training method used by the father who wants to be a positive support and infant coach.

This is a good technique for father or grandmother to use, it promotes breastfeeding and helps develop and maintain the correct sucking technique. Read over what was suggested for mothers – there are a few additional remarks for fathers and others.

First – wash your hands. Hand washing was a more important medical discovery than antibiotics. Have 20-30 mls expressed breast milk in a small plastic container or feeding bottle. You will need a No 5 IG tube and a 2-3 ml syringe for cleaning it after use. Never microwave the tube! Do not cut the tube.

Lie baby comfortably on a small pillow. Some men with big hands feel comfortable holding baby in front of them – face to face – with baby resting on your arms.

If you have large fingers, use one which baby can tolerate – similar diameter to that used successfully by the mother. Place it firmly on the baby’s hard palate behind the gum, to stimulate sucking sensors. The finger should not move in and out of the mouth

Baby should close his lips around your finger – the lips and tongue making an airtight seal – like an efficient gasket in the carburettor.

Note the position of the tongue – you should not be able to feel the hardness of the baby’s gum on your finger – the tongue should protect your finger from pressure by the top gum.

Insert the end of the tubing beside your finger, and ensure the other end is in the milk. If milk is not flowing, check that the cap is not sealing the end of the tube. You can prime the tube with milk if necessary.

If baby allows milk to leak from his mouth, apply firm pressure to the chin and cheeks to close the mouth. No leaky gaskets here! There should not be any slurping, leaking or clicking.

The milk should go from the container to the mouth in two sucks – if it is slower, a few centimetres at a time, it shows that the suck is not efficient. If it was a new vacuum cleaner, you would return it to the shop!

Remember mouth mechanics are like the function of the carburettor – baby needs to create a vacuum in his mouth. There should be no leakage. He should be able to maintain a continuous suck-swallow-breathe action (SSB), repetitively for about 8-10 minutes.

If the top of the milk in the container is level with his mouth, and the feed goes well, he is transferring all the milk himself.

If you raise the container above his mouth, then it becomes a ‘gravity assisted feed’. In a small way this mimics the MER and helps him to cope with an increased flow of milk, by achieving bigger swallows (tongue goes down at the back). Only do this for 5-6 sucks, then return the milk container to the previous level. If you have run out of EBM and it seems absolutely necessary, formula can be given in the same way.

If baby takes your index finger well, you can improve the angle of gape by graduating to your middle finger, then later your thumb – but use the finger that baby is most comfortable with. When baby finishes his feed, burp him, and change him put him to bed.

Wash your hands again – congratulate yourself on a job well done. Check if there is something ready for dinner.